Healthcare Provider Details

I. General information

NPI: 1578186565
Provider Name (Legal Business Name): AUDREY DAWN COMPTON PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ALBERT AVE
SCOTT CITY KS
67871-6117
US

IV. Provider business mailing address

201 ALBERT AVE
SCOTT CITY KS
67871-6117
US

V. Phone/Fax

Practice location:
  • Phone: 620-872-5811
  • Fax:
Mailing address:
  • Phone: 620-872-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02404
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: